IGA AMENDMENT RE DIETETIC INTERNSHIP PROGRAM WITH ADHS.PDF

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ARIZONA DEPARTMENT OF
(GA) HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT AMENDMENT 1740 W. Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
• Contract No: ADHS11-005228 Amendment No 3 Procurement Specialist
Tracey Thomas
Dietetic Internship Program
Effective October 1, 2013, it is mutually agreed that the Intergovernmental Agreement referenced is amended as follows:
1. Terms and Conditions, Section 4, Contract Administration and Operation, Item 4.13, Scrutinized Businesses in
Amendment One (1) is hereby deleted.
2. The Price Sheet in Amendment Two (2) is hereby revised and replaced by the Price Sheet, Amendment Three
(3). The total Price Sheet is $92,327.00 with the following changes:
a. Personnel Costs decreased by $2,285.00;
b. Employee Related Expenses decreased by $284.00;
c. Travel Expenses decreased by $150.00;
d. Other Operating Expenses increased by $1,959.00; and
e. Indirect Costs decreased by $843.00.
In ProcureAZ the Contract pricing "Items" tab will be updated upon execution of this Amendment Three (3).
All other provisions of this a. reement remain unchanged.
CONTRACTOR SIGNATURE
Maricopa County Public Health
Contractor Name Contractor Authorized Signature
4041 North Central Avenue, Suite 1400
Address Printed Name
Phoenix Arizona 85012
City State Zip Title
CONTRACTOR ATTORNEY SIGNATURE This Intergovernmental Agreement Amendment shall be effective the
Pursuant to A.R,S. § 11-952, the undersigned public agency attorney date indicated, The Public Agency is hereby cautioned not to commence
has determined that this Intergovernmental Agreement is in proper any billable work or provide any material, service or construction under
form and is within the powers and authority granted under the laws of this IGA until the IGA has been executed by an authorized ADHS
the State of Arizona. signatory.
State of Arizona
Signed this day of 2013
Signature Date
Printed Name Procurement Officer
RESERVED FOR USE BY THE SECRETARY OF STATE
Attorney General Contract No. P0012012000033. which is an
Agreement between public agencies, has been reviewed pursuant to Under House Bill 2011, A.R.S. § 11-952
A.R.S. § 11-952 by the undersigned Assistant Attorney General, who
has determined that it is in proper form and is within the powers and was amended to remove the requirement
authority granted under the laws of the State of Arizona. that Intergovernmental Agreements be filed
with the Secretary of State.
Signature Date
Assistant Attorney General
Printed Name:
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ARIZONA DEPARTMENT OF
444, HEALTH SERVICES
41/IW INTERGOVERNMENTAL AGREEMENT (VGA) AMENDMENT 1740 W. Adams, Room 303
Phoenix, Arizona 65007
(446, Ire ' (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS11 -005228 Amendment No. 3 Procurement Tracey Thomas Specialist
PRICE SHEET
Effective Date: October 1, 2013 to September 30, 2014
LINE ITEM BUDGET AMOUNT
PERSONNEL COSTS/SALARY $ 49,715.00
EMPLOYEE RELATED EXPENSES $ 17,940.00
PROFESSIONAL & OUTSIDE SERVICES $ 1,500.00
TRAVEL EXPENSES $ 4,400.00
OCCUPANCY EXPENSES
OTHER OPERATING EXPENSES $ 6,729.00
CAPITAL
INDIRECT COSTS EXPENSES (if authorized) $ 12,043.00
TOTAL $ 92,327.00
LINE ITEM BUDGET TRANSFERS
Upon receipt of written authorization from the ADHS Program Manager, the Contractor is authorized to transfer up to 10%
of the total budget amount between funded line items. Transfers exceeding 10% of the total to a non-funded line item shall
require a contract amendment.
INDIRECT COSTS EXPENSES
Any changes in indirect expenses will require submission of supporting documentation and written approval from ADHS.
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